(CS-138) Erosive Pustular Dermatosis of the Scalp Treated with Fragmented Fish Skin*

Erosive Pustular Dermatosis of the scalp (EPDS), though rare, is a chronic inflammatory disorder. ¹The condition typically affects elderly people and presents with keratotic yellow-brown crusts, erosions, purulent discharge, and lakes of pus. It is most commonly observed on the scalp in the setting of chronically sun-damaged skin. Bacterial cultures often reveal sterile fluid within the pustules. The condition slowly progresses over many years. ²Topical high-potency steroids are often used to treat EPDS with modest results. The following 2 case studies illustrate a possible solution to help treat this frustrating condition in two patients who were recalcitrant to traditional therapies.

Methods:

Case #1: Fragmented fish skin* was applied to EPDS and covered with Adaptic, Steri strips, gauze, and Tegaderm.
Case #2: Curettage was performed prior to fragmented fish skin* application. Prior to each application, bandages were removed, and area was cleaned with sterile gauze and hydrogen peroxide, then covered with Adaptic, Hydrofera Blue, Tegaderm, and Hypafix. The bandage was left intact for 1 week
Patient returned weekly for follow up to monitor progress. Chemical cauterization was used 4 weeks post 3^rd fish skin application. Acellular dermal matrix was used for 5^th application.   6^th and 7^th applications were applied 1 week apart.

Results:

  Significant granulation tissue and healing were noted within the first week of application for both case studies.

  Case study #1 required 1 application to reach clearance of EPDS.
  Case study #2 required 6 applications of fragmented fish skin* and 1 acellular dermal matrix application. Applications were spaced 4-5 weeks apart. He is being followed bimonthly and is progressing towards resolution.

Discussion:

Case #1 achieved excellent granulation tissue to treat his current EPDS

  Case #2: achieved acceptable granulation tissue and is progressing towards resolution

Trademarked Items: *KerecisTM, Kerecis, Isafjordur, Iceland
Hydrofera Blue, Tegaderm, and Hypafix.

References:

References:
1Starace, Michela et al. “Erosive Pustular dermatosis of the scalp: challenges and solutions.”
Clinical, cosmetic and investigational dermatology vol. 12 691-698. 12 Sep. 2019, doi:10.2147/CCID.S223317
2 Michelerio, Andrea et al. “Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study
of Fifty Cases.” Dermatopathology (Basel, Switzerland) vol. 8,4 450-462. 23 Sep. 2021, doi:10.3390/dermatopathology8040048